{"id":3268,"date":"2024-12-12T00:54:32","date_gmt":"2024-12-12T00:54:32","guid":{"rendered":"https:\/\/stagingdechoker.aerohealthcare.com\/?page_id=3268"},"modified":"2025-02-12T23:13:09","modified_gmt":"2025-02-12T23:13:09","slug":"add-a-life-saved","status":"publish","type":"page","link":"https:\/\/dechoker.com\/ca\/add-a-life-saved\/","title":{"rendered":"Saved a Life? Share Your Story&#8230;"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3268\" class=\"elementor elementor-3268\" data-elementor-post-type=\"page\">\n\t\t\t\t<div data-particle_enable=\"false\" data-particle-mobile-disabled=\"false\" class=\"elementor-element elementor-element-9cbe1d4 e-flex e-con-boxed e-con e-parent\" data-id=\"9cbe1d4\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-fe23524 elementor-widget elementor-widget-text-editor\" data-id=\"fe23524\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p data-sourcepos=\"1:1-1:190\">We understand that a choking incident can be a traumatic experience, both for the individual affected and those who witness or assist. We hope that the situation resolved safely and swiftly.<\/p><p data-sourcepos=\"3:1-3:240\">We kindly request your time to share your experience with us. Your insights can help raise awareness about choking prevention and emergency response.<\/p><p data-sourcepos=\"3:1-3:240\">While de-identified data may be used for promotional and research purposes, please be assured that no personally identifiable information will be shared without your express permission.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68a59cd elementor-widget elementor-widget-wpforms\" data-id=\"68a59cd\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<style id=\"wpforms-css-vars-elementor-widget-68a59cd\">\n\t\t\t\t.elementor-widget-wpforms.elementor-element-68a59cd {\n\t\t\t\t--wpforms-button-background-color: #d91a21;\n--wpforms-field-border-radius: 3pxpx;\n--wpforms-button-border-radius: 3pxpx;\n--wpforms-page-break-color: #d91a21;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n--wpforms-container-shadow-size-box-shadow: none;\n\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-form-abandonment wpforms-container-save-resume wpforms-render-modern\" id=\"wpforms-3260\"><form id=\"wpforms-form-3260\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"3260\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/ca\/wp-json\/wp\/v2\/pages\/3268\/?wpforms_form_id=3260\" data-token=\"1a7a0c1cc217e9315edf06fc6ed5c915\" data-token-time=\"1740170350\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"10\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 10<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:10%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-3260-field_34-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"34\"><\/div><div id=\"wpforms-3260-field_52-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"52\"><h3 id=\"wpforms-3260-field_52\" aria-errormessage=\"wpforms-3260-field_52-error\" aria-describedby=\"wpforms-3260-field_52-description\">Tell Us A LIttle About Yourself<\/h3><div id=\"wpforms-3260-field_52-description\" class=\"wpforms-field-description\">This will help us reach you if we need to, and don't worry, all your information is processed according to our <a href=\"https:\/\/dechoker.com\/ca\/privacy-policy\/\">privacy policy<\/a>.<\/div><\/div><div id=\"wpforms-3260-field_24-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Your Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_24\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][24][first]\" aria-errormessage=\"wpforms-3260-field_24-error\" required><label for=\"wpforms-3260-field_24\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_24-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][24][last]\" aria-errormessage=\"wpforms-3260-field_24-last-error\" required><label for=\"wpforms-3260-field_24-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3260-field_25-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_25\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-3260-field_25\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][25]\" spellcheck=\"false\" aria-errormessage=\"wpforms-3260-field_25-error\" required><\/div><div id=\"wpforms-3260-field_45-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"45\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-3260-field_53-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"53\"><h3 id=\"wpforms-3260-field_53\" aria-errormessage=\"wpforms-3260-field_53-error\">Where and When Did the Choking Incident Happen?<\/h3><\/div><div id=\"wpforms-3260-field_1-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_1\">Date of the incident <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-3260-field_1\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][1][date]\" aria-errormessage=\"wpforms-3260-field_1-error\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-3260-field_2-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"2\"><fieldset><legend class=\"wpforms-field-label\">Location of the incident<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3260-field_2\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][2][address1]\" aria-errormessage=\"wpforms-3260-field_2-error\" ><label for=\"wpforms-3260-field_2\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3260-field_2-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][2][address2]\" aria-errormessage=\"wpforms-3260-field_2-address2-error\" ><label for=\"wpforms-3260-field_2-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3260-field_2-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][2][city]\" aria-errormessage=\"wpforms-3260-field_2-city-error\" ><label for=\"wpforms-3260-field_2-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_2-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][2][state]\" aria-errormessage=\"wpforms-3260-field_2-state-error\" ><label for=\"wpforms-3260-field_2-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3260-field_2-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][2][postal]\" aria-errormessage=\"wpforms-3260-field_2-postal-error\" ><label for=\"wpforms-3260-field_2-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-3260-field_2-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][2][country]\" aria-errormessage=\"wpforms-3260-field_2-country-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-3260-field_2-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3260-field_36-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"36\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-3260-field_54-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"54\"><h3 id=\"wpforms-3260-field_54\" aria-errormessage=\"wpforms-3260-field_54-error\" aria-describedby=\"wpforms-3260-field_54-description\">Who was Involved in the Incident?<\/h3><div id=\"wpforms-3260-field_54-description\" class=\"wpforms-field-description\">Remember all your information is processed according to our strict <a href=\"https:\/\/dechoker.com\/ca\/privacy-policy\">privacy policy<\/a>.<\/div><\/div><div id=\"wpforms-3260-field_5-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"5\"><fieldset><legend class=\"wpforms-field-label\">Name of choking person<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_5\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][5][first]\" aria-errormessage=\"wpforms-3260-field_5-error\" aria-describedby=\"wpforms-3260-field_5-description\" ><label for=\"wpforms-3260-field_5\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_5-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][5][last]\" aria-errormessage=\"wpforms-3260-field_5-last-error\" aria-describedby=\"wpforms-3260-field_5-description\" ><label for=\"wpforms-3260-field_5-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><div id=\"wpforms-3260-field_5-description\" class=\"wpforms-field-description\">Optional and will not be published.<\/div><\/fieldset><\/div><div id=\"wpforms-3260-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_3\">Age of the choking person <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3260-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-3260-field_3-error\" required><\/div><div id=\"wpforms-3260-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Sex of choking person <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_4_1\" name=\"wpforms[fields][4]\" value=\"Male\" aria-errormessage=\"wpforms-3260-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_4_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_4_2\" name=\"wpforms[fields][4]\" value=\"Female\" aria-errormessage=\"wpforms-3260-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_4_2\">Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_4_3\" name=\"wpforms[fields][4]\" value=\"Prefer not to say\" aria-errormessage=\"wpforms-3260-field_4_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_4_3\">Prefer not to say<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_6-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_6\">Did they have any pre-existing health problems related to this choking incident<\/label><textarea id=\"wpforms-3260-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-3260-field_6-error\" ><\/textarea><\/div><div id=\"wpforms-3260-field_33-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"33\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-3260-field_55-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"55\"><h3 id=\"wpforms-3260-field_55\" aria-errormessage=\"wpforms-3260-field_55-error\">Tell Us More About the Incident<\/h3><\/div><div id=\"wpforms-3260-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_7\">What did they choke on <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-3260-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-3260-field_7-error\" required><\/div><div id=\"wpforms-3260-field_8-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">What type of obstruction occured <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_8_1\" name=\"wpforms[fields][8]\" value=\"Complete obstruction (silent and could not cough effectively)\" aria-errormessage=\"wpforms-3260-field_8_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_8_1\">Complete obstruction (silent and could not cough effectively)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_8_2\" name=\"wpforms[fields][8]\" value=\"Incomplete or partial obstruction (could cough effectively)\" aria-errormessage=\"wpforms-3260-field_8_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_8_2\">Incomplete or partial obstruction (could cough effectively)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_8_3\" name=\"wpforms[fields][8]\" value=\"Unknown\" aria-errormessage=\"wpforms-3260-field_8_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_8_3\">Unknown<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_9-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-conditional-trigger\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">What other first aid measures were attempted before using the DeChoker <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_1\" name=\"wpforms[fields][9][]\" value=\"Back blows\" aria-errormessage=\"wpforms-3260-field_9_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_1\">Back blows<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Chest thrusts\" aria-errormessage=\"wpforms-3260-field_9_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_2\">Chest thrusts<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_3\" name=\"wpforms[fields][9][]\" value=\"Abdominal thrusts\" aria-errormessage=\"wpforms-3260-field_9_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_3\">Abdominal thrusts<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_4\" name=\"wpforms[fields][9][]\" value=\"CPR\" aria-errormessage=\"wpforms-3260-field_9_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_4\">CPR<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_5\" name=\"wpforms[fields][9][]\" value=\"None\" aria-errormessage=\"wpforms-3260-field_9_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_5\">None<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-3260-field_9_6\" name=\"wpforms[fields][9][]\" value=\"Other\" aria-errormessage=\"wpforms-3260-field_9_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_9_6\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_10-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"10\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_10\">Other first aid measures applied<\/label><textarea id=\"wpforms-3260-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" aria-errormessage=\"wpforms-3260-field_10-error\" ><\/textarea><\/div><div id=\"wpforms-3260-field_37-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"37\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-3260-field_56-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"56\"><h3 id=\"wpforms-3260-field_56\" aria-errormessage=\"wpforms-3260-field_56-error\">How Was the DeChoker Used?<\/h3><\/div><div id=\"wpforms-3260-field_11-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">What position was this person in whilst the DeChoker was being used <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_11\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_11_1\" name=\"wpforms[fields][11]\" value=\"Sitting\" aria-errormessage=\"wpforms-3260-field_11_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_11_1\">Sitting<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_11_2\" name=\"wpforms[fields][11]\" value=\"Lying down\" aria-errormessage=\"wpforms-3260-field_11_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_11_2\">Lying down<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_11_3\" name=\"wpforms[fields][11]\" value=\"Standing\" aria-errormessage=\"wpforms-3260-field_11_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_11_3\">Standing<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_11_4\" name=\"wpforms[fields][11]\" value=\"Side position\" aria-errormessage=\"wpforms-3260-field_11_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_11_4\">Side position<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_11_5\" name=\"wpforms[fields][11]\" value=\"Other\" aria-errormessage=\"wpforms-3260-field_11_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_11_5\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_44-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"44\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_44\">Describe the position<\/label><input type=\"text\" id=\"wpforms-3260-field_44\" class=\"wpforms-field-medium\" name=\"wpforms[fields][44]\" aria-errormessage=\"wpforms-3260-field_44-error\" ><\/div><div id=\"wpforms-3260-field_12-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"12\"><fieldset><legend class=\"wpforms-field-label\">Was this person conscious whilst the DeChoker was used <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_12\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_12_1\" name=\"wpforms[fields][12]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_12_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_12_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_12_2\" name=\"wpforms[fields][12]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_12_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_12_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_12_3\" name=\"wpforms[fields][12]\" value=\"Unknown\" aria-errormessage=\"wpforms-3260-field_12_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_12_3\">Unknown<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_13-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_13\">How many times was the DeChoker operated <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3260-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-3260-field_13-error\" aria-describedby=\"wpforms-3260-field_13-description\" required><div id=\"wpforms-3260-field_13-description\" class=\"wpforms-field-description\">Count the number of completed place and pull and reset sequences.<\/div><\/div><div id=\"wpforms-3260-field_38-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"38\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-3260-field_57-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"57\"><h3 id=\"wpforms-3260-field_57\" aria-errormessage=\"wpforms-3260-field_57-error\">What Happened After Using the DeChoker?<\/h3><\/div><div id=\"wpforms-3260-field_14-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Was the obstruction dislodged by using the DeChoker <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_14_1\" name=\"wpforms[fields][14]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_14_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_14_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_14_2\" name=\"wpforms[fields][14]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_14_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_14_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_16-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Do you believe the use of the DeChoker saved this persons life <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_16\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_16_1\" name=\"wpforms[fields][16]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_16_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_16_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_16_2\" name=\"wpforms[fields][16]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_16_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_16_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_16_3\" name=\"wpforms[fields][16]\" value=\"Unsure\" aria-errormessage=\"wpforms-3260-field_16_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_16_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_15-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_15\">Duration of the incident <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-3260-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-3260-field_15-error\" aria-describedby=\"wpforms-3260-field_15-description\" required><div id=\"wpforms-3260-field_15-description\" class=\"wpforms-field-description\">How many minutes from the choking event until recovery.<\/div><\/div><div id=\"wpforms-3260-field_39-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"39\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"6\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-3260-field_58-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"58\"><h3 id=\"wpforms-3260-field_58\" aria-errormessage=\"wpforms-3260-field_58-error\">Was there any Follow Up Medical Attention?<\/h3><\/div><div id=\"wpforms-3260-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"43\"><fieldset><legend class=\"wpforms-field-label\">Did they receive any follow-up medical attention after the event<\/legend><ul id=\"wpforms-3260-field_43\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_43_1\" name=\"wpforms[fields][43]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_43_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_43_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_43_2\" name=\"wpforms[fields][43]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_43_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_43_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_43_3\" name=\"wpforms[fields][43]\" value=\"Unsure\" aria-errormessage=\"wpforms-3260-field_43_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_43_3\">Unsure<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_17-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"17\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_17\">If so, what were the findings of the medical practioner <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3260-field_17\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-3260-field_17-error\" aria-describedby=\"wpforms-3260-field_17-description\" required><\/textarea><div id=\"wpforms-3260-field_17-description\" class=\"wpforms-field-description\">Describe any observations, issues or complications that may have been diagnosed.<\/div><\/div><div id=\"wpforms-3260-field_40-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"40\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"7\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"7\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-3260-field_59-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"59\"><h3 id=\"wpforms-3260-field_59\" aria-errormessage=\"wpforms-3260-field_59-error\">Tell Us A Little About Your Prior Experience or Training<\/h3><\/div><div id=\"wpforms-3260-field_23-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Have you had any experience with a choking incident before <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_23\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_23_1\" name=\"wpforms[fields][23]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_23_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_23_2\" name=\"wpforms[fields][23]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_23_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_23_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_18-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">What is your highest level of emergency training <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_18\" class=\"wpforms-field-required\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_7\" name=\"wpforms[fields][18]\" value=\"None\" aria-errormessage=\"wpforms-3260-field_18_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_7\">None<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_1\" name=\"wpforms[fields][18]\" value=\"Basic Life Support (e.g. CPR Training)\" aria-errormessage=\"wpforms-3260-field_18_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_1\">Basic Life Support (e.g. CPR Training)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_2\" name=\"wpforms[fields][18]\" value=\"Advanced Life Support\" aria-errormessage=\"wpforms-3260-field_18_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_2\">Advanced Life Support<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_3\" name=\"wpforms[fields][18]\" value=\"Nurse\" aria-errormessage=\"wpforms-3260-field_18_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_3\">Nurse<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_4\" name=\"wpforms[fields][18]\" value=\"Paramedic\" aria-errormessage=\"wpforms-3260-field_18_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_4\">Paramedic<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_5\" name=\"wpforms[fields][18]\" value=\"Doctor\" aria-errormessage=\"wpforms-3260-field_18_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_5\">Doctor<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_18_6\" name=\"wpforms[fields][18]\" value=\"Other\" aria-errormessage=\"wpforms-3260-field_18_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_18_6\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_19-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"19\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_19\">Other emergency training<\/label><input type=\"text\" id=\"wpforms-3260-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" aria-errormessage=\"wpforms-3260-field_19-error\" ><\/div><div id=\"wpforms-3260-field_41-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"41\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"8\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"8\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-3260-field_60-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"60\"><h3 id=\"wpforms-3260-field_60\" aria-errormessage=\"wpforms-3260-field_60-error\">We&#039;d Love to Share Your Live Saving Story With The World<\/h3><\/div><div id=\"wpforms-3260-field_20-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_20\">How would you describe your experience of using the DeChoker <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3260-field_20\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][20]\" aria-errormessage=\"wpforms-3260-field_20-error\" aria-describedby=\"wpforms-3260-field_20-description\" required><\/textarea><div id=\"wpforms-3260-field_20-description\" class=\"wpforms-field-description\">With your permission,  your story may be published in our <em><strong>Real Lives Saved<\/strong><\/em> blog - you can read more about some of the the <a href=\"https:\/\/dechoker.com\/ca\/real-lives-saved\/\">incredible lives saved here...<\/a>.<\/div><\/div><div id=\"wpforms-3260-field_47-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">Do you give permission for your story to be published<\/legend><ul id=\"wpforms-3260-field_47\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_47_1\" name=\"wpforms[fields][47]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_47_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_47_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_47_2\" name=\"wpforms[fields][47]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_47_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_47_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_48-container\" class=\"wpforms-field wpforms-field-file-upload\" data-field-id=\"48\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_48\">Do you have any photos or videos you&#039;d like to share with your story<\/label><div\n\t\tclass=\"wpforms-uploader\"\n\t\tdata-field-id=\"48\"\n\t\tdata-form-id=\"3260\"\n\t\tdata-input-name=\"wpforms_3260_48\"\n\t\tdata-extensions=\"mpg,mov,wmv,png,gif,jpg,doc,xls,ppt,pdf\"\n\t\tdata-max-size=\"256000000\"\n\t\tdata-max-file-number=\"5\"\n\t\tdata-post-max-size=\"256000000\"\n\t\tdata-max-parallel-uploads=\"4\"\n\t\tdata-parallel-uploads=\"true\"\n\t\tdata-file-chunk-size=\"2097152\">\n\t<div class=\"dz-message\">\n\t\t<svg viewBox=\"0 0 1024 1024\" focusable=\"false\" data-icon=\"inbox\" width=\"50px\" height=\"50px\" fill=\"currentColor\" aria-hidden=\"true\">\n\t\t\t<path d=\"M885.2 446.3l-.2-.8-112.2-285.1c-5-16.1-19.9-27.2-36.8-27.2H281.2c-17 0-32.1 11.3-36.9 27.6L139.4 443l-.3.7-.2.8c-1.3 4.9-1.7 9.9-1 14.8-.1 1.6-.2 3.2-.2 4.8V830a60.9 60.9 0 0 0 60.8 60.8h627.2c33.5 0 60.8-27.3 60.9-60.8V464.1c0-1.3 0-2.6-.1-3.7.4-4.9 0-9.6-1.3-14.1zm-295.8-43l-.3 15.7c-.8 44.9-31.8 75.1-77.1 75.1-22.1 0-41.1-7.1-54.8-20.6S436 441.2 435.6 419l-.3-15.7H229.5L309 210h399.2l81.7 193.3H589.4zm-375 76.8h157.3c24.3 57.1 76 90.8 140.4 90.8 33.7 0 65-9.4 90.3-27.2 22.2-15.6 39.5-37.4 50.7-63.6h156.5V814H214.4V480.1z\"><\/path>\n\t\t<\/svg>\n\t\t<span class=\"modern-title\">Click or drag files to this area to upload.<\/span>\n\n\t\t\t\t\t<span class=\"modern-hint\">You can upload up to 5 files.<\/span>\n\t\t\t<\/div>\n<\/div>\n<input\n\t\ttype=\"text\"\n\t\tautocomplete=\"off\"\n\t\treadonly\n\t\tclass=\"dropzone-input\"\n\t\tstyle=\"position:absolute!important;clip:rect(0,0,0,0)!important;height:1px!important;width:1px!important;border:0!important;overflow:hidden!important;padding:0!important;margin:0!important;\"\n\t\tid=\"wpforms-3260-field_48\"\n\t\tname=\"wpforms_3260_48\" \t\tvalue=\"\">\n<div id=\"wpforms-3260-field_48-description\" class=\"wpforms-field-description\">With your permission these may be published on our <em>Real Lives Saved<\/em> board.<\/div><\/div><div id=\"wpforms-3260-field_21-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">How did you first hear about the DeChoker <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_21\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_1\" name=\"wpforms[fields][21]\" value=\"Search Engine (e.g. Google or Bing)\" aria-errormessage=\"wpforms-3260-field_21_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_1\">Search Engine (e.g. Google or Bing)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_2\" name=\"wpforms[fields][21]\" value=\"Social Media Advertising (e.g. an ad on Twitter or TikTok)\" aria-errormessage=\"wpforms-3260-field_21_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_2\">Social Media Advertising (e.g. an ad on Twitter or TikTok)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_3\" name=\"wpforms[fields][21]\" value=\"Social Media Post (e.g. a friends post on Facebook or Twitter)\" aria-errormessage=\"wpforms-3260-field_21_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_3\">Social Media Post (e.g. a friends post on Facebook or Twitter)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_4\" name=\"wpforms[fields][21]\" value=\"Television\" aria-errormessage=\"wpforms-3260-field_21_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_4\">Television<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_5\" name=\"wpforms[fields][21]\" value=\"Word of Mouth\" aria-errormessage=\"wpforms-3260-field_21_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_5\">Word of Mouth<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_21_6\" name=\"wpforms[fields][21]\" value=\"Other\" aria-errormessage=\"wpforms-3260-field_21_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_21_6\">Other<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-3260-field_22-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"22\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_22\">Other source<\/label><input type=\"text\" id=\"wpforms-3260-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-3260-field_22-error\" ><\/div><div id=\"wpforms-3260-field_42-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"42\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"9\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Previous<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"9\" data-formid=\"3260\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Next<\/button><a href=\"#\" class=\"wpforms-save-resume-button\"><span>Save and Resume Later<\/span><\/a><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10 last \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-3260-field_61-container\" class=\"wpforms-field wpforms-field-divider\" data-field-id=\"61\"><h3 id=\"wpforms-3260-field_61\" aria-errormessage=\"wpforms-3260-field_61-error\">Where Can We Send Your FREE Replacement Dechoker?<\/h3><\/div><div id=\"wpforms-3260-field_62-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"62\"><fieldset><legend class=\"wpforms-field-label\">Would you like to claim your FREE replacement Dechoker? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-3260-field_62\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_62_1\" name=\"wpforms[fields][62]\" value=\"Yes\" aria-errormessage=\"wpforms-3260-field_62_1-error\" aria-describedby=\"wpforms-3260-field_62-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_62_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-3260-field_62_2\" name=\"wpforms[fields][62]\" value=\"No\" aria-errormessage=\"wpforms-3260-field_62_2-error\" aria-describedby=\"wpforms-3260-field_62-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-3260-field_62_2\">No<\/label><\/li><\/ul><div id=\"wpforms-3260-field_62-description\" class=\"wpforms-field-description\">To claim your FREE replacement mask, please let us know where you purchased your original DeChoker and your preferred delivery address.<\/div><\/fieldset><\/div><div id=\"wpforms-3260-field_50-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"50\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_50\">Name and Location or Website of the store you purchased the DeChoker from <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-3260-field_50\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-3260-field_50-error\" required><\/textarea><\/div><div id=\"wpforms-3260-field_26-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"26\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-3260-field_26\">Your Contact Phone Number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-3260-field_26\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][26]\" aria-label=\"Your Contact Phone Number\" aria-errormessage=\"wpforms-3260-field_26-error\" required><\/div><div id=\"wpforms-3260-field_27-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"27\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Your Preferred Delivery Address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3260-field_27\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][27][address1]\" aria-errormessage=\"wpforms-3260-field_27-error\" required><label for=\"wpforms-3260-field_27\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-3260-field_27-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][27][address2]\" aria-errormessage=\"wpforms-3260-field_27-address2-error\" ><label for=\"wpforms-3260-field_27-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3260-field_27-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][27][city]\" aria-errormessage=\"wpforms-3260-field_27-city-error\" required><label for=\"wpforms-3260-field_27-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-3260-field_27-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][27][state]\" aria-errormessage=\"wpforms-3260-field_27-state-error\" required><label for=\"wpforms-3260-field_27-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-3260-field_27-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][27][postal]\" aria-errormessage=\"wpforms-3260-field_27-postal-error\" required><label for=\"wpforms-3260-field_27-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-3260-field_27-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][27][country]\" aria-errormessage=\"wpforms-3260-field_27-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-3260-field_27-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-3260-field_35-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"35\"><\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v2\" style=\"display:none;\"><div class=\"g-recaptcha\" data-sitekey=\"6Le-StQqAAAAAJPiyIFAd90lELVXXYSVpt4xGnLa\"><\/div><input type=\"text\" name=\"g-recaptcha-hidden\" 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Alternatively, you can copy and save the link below.<\/p>\n<p>Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.<\/p>\n\t<\/div>\n\n\t<div class=\"wpforms-save-resume-actions\">\n\t\t\t\t\t<div class=\"wpforms-field\">\n\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\tCopy Link\t\t\t\t<\/label>\n\t\t\t\t<div class=\"wpforms-save-resume-shortcode-container\">\n\t\t\t\t\t<input type=\"text\" class=\"wpforms-save-resume-shortcode\" value=\"\" disabled \/>\n\t\t\t\t\t<span class=\"wpforms-save-resume-shortcode-copy\" title=\"Copy resume link to clipboard\">\n\t\t\t\t\t\t\t<span class=\"copy-icon\"><\/span>\n\t\t\t\t\t\t<\/span>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\n\t\t\t\t\t<form class=\"wpforms-validate wpforms-form wpforms-save-resume-email-notification\" method=\"post\" action=\"\/ca\/wp-json\/wp\/v2\/pages\/3268\/\" data-token=\"8cc3132f2dc75f362fbd76d6f4050327\">\n\t\t\t\t<div class=\"wpforms-field wpforms-field-email\">\n\t\t\t\t\t<label class=\"wpforms-field-label wpforms-save-resume-label\">\n\t\t\t\t\t\tEmail\t\t\t\t\t\t<span class=\"wpforms-required-label\">*<\/span>\n\t\t\t\t\t<\/label>\n\t\t\t\t\t<input type=\"email\" name=\"wpforms[save_resume_email]\" required>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpforms-submit-container\">\n\t\t\t\t\t<input type=\"hidden\" id=\"_wpnonce\" name=\"_wpnonce\" value=\"551d3222bc\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/ca\/wp-json\/wp\/v2\/pages\/3268\/\" \/>\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[form_id]\" value=\"3260\">\n\t\t\t\t\t<input type=\"hidden\" name=\"wpforms[entry_id]\" class=\"wpforms-save-resume-entry-id\" value=\"\">\n\t\t\t\t\t<button type=\"submit\" name=\"wpforms[save-resume]\" class=\"wpforms-submit\" value=\"wpforms-submit\" disabled>\n\t\t\t\t\t\tSend Link\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/form>\n\t\t\t<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>We understand that a choking incident can be a traumatic experience, both for the individual affected and those who witness or assist. We hope that the situation resolved safely and swiftly. We kindly request your time to share your experience with us. Your insights can help raise awareness about choking prevention and emergency response. While [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_trash_the_other_posts":false,"footnotes":""},"class_list":["post-3268","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/pages\/3268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/comments?post=3268"}],"version-history":[{"count":25,"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/pages\/3268\/revisions"}],"predecessor-version":[{"id":4271,"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/pages\/3268\/revisions\/4271"}],"wp:attachment":[{"href":"https:\/\/dechoker.com\/ca\/wp-json\/wp\/v2\/media?parent=3268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}